Tumours of the cerebral hemispheres intrinsic

METASTATIC TUMOURS (contd) Management and prognosis:

Corticosteriods (dexamethasone) have a dramatic, rapid effect, producing clinical improvement in most patients.

- Solitary lesions: If the tumour lies in an accessible site, complete excision followed by radiotherapy provides good results - survival usually depends on the extent of extracranial disease and its ability to respond to treatment rather than on intracranial recurrences. Stereotactic radiosurgery provides a valuable alternative, particularly for lesions less than 3 cms in diameter. In patients with no other evidence of systemic cancer, the median survival period approaches 2 years.In patients with other evidence of systemic disease, results are less good with a median survival of 8 months.

- Multiple lesions: In these patients, operative removal is seldom practical or possible. Provided no doubt exists about the diagnosis (i.e. multiple abscesses or tuberculomata may resemble metastatic deposits) then whole brain irradiation is administered. PRIMARY CNS LYMPHOMA (PCNSL) (syn. microglomatosis, non hodgkin's lymphoma) Single or multiple cell lymphoma usually lie deep within the basal ganglia or in the periventricular region. Some are discrete lesions, others extensively invade surrounding brain. Histology shows sleeves of primitive reticulum cells extending outwards from the blood vessels. The incidence is significantly increased in AIDS and in immunocompromised patients.

CSF examination is important; 30% of patients with PCNSL show positive cytology. A positive Epstein-Barr test ^--

Management: In AIDS patients, CT and MRI finding of PCNSL appear similar to toxoplasmosis; antiprotozoal therapy should be tried first. Failure to respond indicates the need for biopsy. Steroids can cause dramatic shrinkage, and the CT scan should be repeated if any delay occurs prior to biopsy. Radiotherapy also has dramatic effects, but with this treatment alone, the median survival period is only 10-12 months. Recent studies show that chemotherapy (in patients with a normal immune system) can increase median survival to up to 44 months. Some now advocate delaying radiotherapy treatment until a recurrence occurs. AIDS patients, who can only receive radiotherapy, have a median survival of 3 months.

GANGLIOGLIOMA

This is a rare tumour occurring in the younger age group (< 30 years), composed of abnormal neuronal growth mixed with a glial component. The proportion of each component varies from patient to patient. Growth is slow and malignant change uncommon; when this occurs it probably develops in the glial component.

Management follows that of low grade astrocytomas. NEUROBLASTOMA

Rarely occurs intracranially in children < 10 years. Highly cellular, malignant lesion composed of small round 312 cells, some showing neuronal differentiation.

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